Image
image
image
image

Retailer's Insurance Renewal Form...

Please fill out the following form. Once you have completed the form, click the Submit button to send your information. Your insurance renewal will be handled promptly.

NOTE: Make sure you put in your correct email address as a copy of this submission will be emailed to that address.

Client Code:
 (Refer Email)
Insured Name:
Email Address:
No.of employees:
Occupation:
Occupation - Please give full details of your business operations:

Protection of your business property
This coverage pays to repair or replace your property if
its damaged by fire or other covered loss.

Please nominate a sum insured for:
The Buildings $
Contents & stock $
The sum insured should represent the full replacement value.

Protection of your business income
This cover reimburses you for your actual loss of income for up to 12 months
resulting from a covered loss to your property.

Please nominate a sum insured for:
Total Annual Income
The sum insured should represent the total annual turnover of the business.

Protection against liability claims
Public liability insurance protects you and your business against the financial risk of being found liable to a third party for death or injury, loss or damage of property or
economic loss resulting from your negligence

Please nominate a sum insured for:
Limit of Indemnity

Does the business import or export goods? Yes    No
Does the business perform work away from your premises? Yes    No
Do you use sub-contractors or labour-hire? Yes    No

Notes:
If there are any further comments, please detail here:






image


 image
image